Surfactant Replacement in Neonates with Respiratory Distress Syndrome Type The innovation of surfactant replacement therapy in the treatment of respiratory distress syndrome has proven to increase the survival and minimize the complications of the premature neonate. Replacing surfactant has lessened time on ventilators, and allowing the neonate and parents an opportunity to grow together earlier outside of intensive care. This paper will discuss the etiology of respiratory distress syndrome type I, the treatment options and nursing care of the neonate during surfactant replacement. Respiratory distress syndrome type I is a decrease production of surfactant, a noncelluar chemical produced in the type II alveolar in the lungs that's primary function is to decrease the surface tensions and attraction between the type I alveolar walls. Respiration requires the alveolar walls to inflate and deflate continuously, while ventilating the alveoli are exposed to moisture causing an attraction between the alveolar walls. (Kenner, Lott, & Flandermeyer, 271) Surfactant primary function is to neutralize the attraction to prevent alveolar collapse during deflation. The fetus begins to develop the type II alveoli at 22nd to 24th week of gestation, however these immature alveoli are incapable of supplying enough surfactant to meet the infant's respiratory needs. The fetus surfactant production begins to become adequate at the middle terminal stage of alveoli development and production becomes optimal at the 34th-to-36th week. (Porth, 1306) There are four types of surfactant produced by the type 2 alveoli known as primary surfactant proteins SP-A, SP-B, SP-C, and SP-D. SP-A and SP-D roles are inhibiting production of surfactant i... ... middle of paper ... ...Reid, S. (2000). Targeted early rescue surfactant in ventilated preterm infants using the click test. Pediatrics. 106. (3). 589 Porth, C. (1998). Pathophysiology. (5th ed.) Philadelphia, Pennsylvania. Lippincott Publishing Rodriquez, R., & Martin, R. (1999). Exogenous surfactant in newborns. Respiratory Care Clinics of North America 5. (4), 595-616 Tzong-Jin, W., & Kuo-Inn, T. (1996). Transfusion-Related acute lung injury treated with surfactant in a neonate. European Journal of Pediatrics. 155. (7). 589-591. Uebel, P. (1999). A case study of antenatal distress and consequent neonatal respiratory distress. Neonatal Network. 18 (5). 67-70 Woodrum, D.(1998). Practice standards for administration of Exogenous Surfactant. (Survanta). University of Washington Academic Medical Center. Available: Http://neonatal.peds.washington.edu/NICU-WEB/surf.stm Accessed: 2/08/01.
Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety ro...
Laurie was born on July 11, 1989 at Henrico Doctors Richmond, VA. Weighing 3lbs and 5ozs and 15 inches in length. At birth the nurses do an APGAR score that scores from 0 to 10 and most healthy babies score from 7 to 10. This APGAR is to measure the appearance, pulse, grimace, activity, and respiration (Feldman, 2014). After birth Laurie scored a 5 all together on the APGAR score by this the doctors took Laurie away to be placed on oxygen to help her to breathe. With preterm babies they are developmentally immature due to lungs do not have enough surfactant to allow proper oxygen to pass through the body, not enough subcutaneous fat to keep warm and so on (Christensen & Kockrow, 2011). She was placed in
He also suggested drying the neonate and providing tactile stimulation to encourage breathing, and covering with a dry blanket to maintain warmth. If after thirty seconds of tactile stimulation, the neonate’s breathing is not sufficient, paramedics should follow protocol for newborn resuscitation, see appendix (L) (QAS, 2014; Saunders, 2012). If the neonate is breathing adequately, leave the newborn with the mother and encourage breastfeeding, which stimulates the nipple resulting in a release of oxytocin which promotes uterine contractions (Stables & Rankin,
Mphahlele, R. R. (2007). Caring for premature babies - a clinical guide for nurses. Professional Nursing Today, 11(1), 40-46.
Person, A. & Mintz, M., (2006), Anatomy and Physiology of the Respiratory Tract, Disorders of the Respiratory Tract, pp. 11-17, New Jersey: Human Press Inc.
Gardenhire, D. Rau's respiratory care pharmacology . (8th ed., p. 172). St. Louis, Missouri: Elsevier Mosby.
Modercin-McCarthy M. A., McCue S., Walker J. Preterm infants and stress: A tool for the neonatal nurse. J Perinat Neonatal Nurs, 1997; 10, 62-71.
In the article Post – Traumatic Stress Disorder and Neonatal Intensive Care, written by Marissa Clottey, B.S.N., R.N. and Dana Marie Dillard M.D., focuses on the importance of recognizing the symptoms of Post-Traumatic Stress Disorder in parents whose infant has been admitted to a Neonatal Intensive Care Unit The article also addresses the importance of informing expectant parents of the possibility of developing Post- Traumatic Stress Disorder if their newborn were admitted to the Neonatal Intensive Care Unit.
Asthma attacks can reduce the oxygen supply to your baby and it may feel suffocated, and be under danger.
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that mostly affects premature infants. Premature infants have very few tiny alveoli that are not fully developed for the lungs to function normally. As a result, premature infants need respiratory support to provide oxygen or they need to be under mechanical ventilation in order to support their breathing. However, BPD is a result of the damage to the lungs caused by mechanical ventilation or by the long-term use of supplemental oxygen. This causes dysplasia and scarring of the air sacs and the damage will continue to affect alveoli that develop after birth. It will also affect the blood vessels which make it difficult for blood to go through the lungs, resulting in pulmonary hypertension and even heart failure. Most babies who have BPD are born with respiratory distress syndrome, a breathing disorder wherein fluid builds up in the alveoli which decreases the amount of oxygen reaching the bloodstream resulting in oxygen deprivation. The lungs are not completely formed or are unable to produce adequate surfactant, the liquid that covers the lungs in order to keep them open and aid in breathing once the infant is born. Without adequate surfactant, the lungs can collapse which causes difficulty in breathing. Because of this, the infant is not able to breathe and circulate sufficient levels of oxygen in order to support the other organs of the body. Most common symptoms of BPD are rapid and labored breathing,
According to the Centers for Disease Control and Prevention, one out of every eight babies each year in the United States is born premature. This affects approximately 500,000 babies yearly. Premature babies are defined as babies born more than three weeks before the baby’s due date. Full term babies are born at approximately forty weeks, and premature babies are born at less than thirty-seven weeks. In the final months and weeks of pregnancy, important growth and development occur in the fetus. This is why premature babies are considered to be at-risk for a number of issues. The earlier that a baby is born, the baby’s risks drastically increase for developmental issues.
Many preterm babies are born with medical problems because they simply were not ready to come into the world yet. They will not have very developed primitive reflexes, and they may look a little strange, with translucent skin, misshapen ears, and fine hair covering their entire bodies. One of the biggest problems for premature infants is a condition called Respiratory Distress Syndrome (RDS), in which the lungs do not produce enough surfactant, which is the substance that keeps the airsacs in the lungs from collapsing. If not treated in time, the infant’s brain will become oxygen deprived, which would lead to death. It can cause some brain damage. Another condition that often affects premature babies is Patent Ductus Arteriosus (PDA). This happens when the ductus arteriosus, which connects the pulmonary artery to the aorta, doesn’t close, leading to the infant’s blood not being properly oxgenated. This can also lead to brain damage if not caught in time. Premature infants also may just stop breathing, which is called apnea. This is why they must be closely monitored, for without close supervision, they could die.
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membra...
Since premature babies don't secrete enough surfactant, a substance that is necessary for the alveoli to overcome surface tension, this causes the alveoli to collapse at each breath making it difficult for gas exchange to happen (Trevino). When it collapses, surface area is lower making it more difficult to breathe. The baby then ends up “breathing harder and harder trying to make up for the collapsed airways” (Thoracic Society).
Preterm birth is defined as ‘any neonate whose birth occurs before the thirty seventh week of gestation’1 and represents approximately eight percent of all pregnancies1-4. It is eminent that these preterm infants are at risk of physical and neurological delay, with prolonged hospitalisation and an increased risk of long-term morbidity evident in prior literature3, 5-13. Innovative healthcare over the past thirty years has reduced mortality significantly14, with the survival rate of preterm infants having increased from twenty five percent in 1980 to seventy three percent in 200715. Despite, this drop in mortality long-term morbidity continues to remain within these surviving infants sparking a cause for concern15, 16.